Preoperative Nursing
Care
Surgery
o Performed for:
o Diagnosis
o Cure
o Palliation
o Prevention
o Cosmetic Improvement
o Exploration
Surgical Settings
o Elective Surgery vs. Emergency Surgery
o Inpatient
o Same-Day Admission
o Ambulatory (Same day or Outpatient)
Your Role Preop
o Have knowledge of the nature of the
disorder requiring surgery
o Identify the individual patient’s response to
the stress of surgery
o Have knowledge of the results of
preoperative diagnostic tests
o Identify potential risks and complications
associated with surgery
Obtain health information, including
drug and food allergies
Purpose of
Patient
Interview
Provide and clarify information about
the surgery and anesthesia
Assess emotional state and readiness
Determine expectations
Identify and document surgical site
Identify drugs, OTC medications, and herbs
taken that may affect surgical outcome
Assessment
Goals
Review results of preoperative diagnostic studies
Identify cultural and ethnic factors that may
affect surgical experience
Determine receipt of adequate information from
surgeon to sign informed consent
Determine that consent form is signed and
witnessed
Past Health History
o Diagnosed medical conditions (previous
and current)
o Previous surgeries and problems
o Menstrual/obstetric history
Health History
oFamilial diseases
oInherited traits
oConditions
oReactions/problems to anesthesia
(patient or family)
Assessment: Current Medications
o Prescription and OTC
o Herbs
o Dietary supplements
o Antiplatelets/NSAIDs
o Recreational: Drugs, Alcohol, Tobacco
Assessment: Allergies
o Allergies (drug and nondrug)
o Screen for latex allergy
Confirms the presence or
absence of diseases
Assessment:
Review of
Systems
Alerts to areas to closely
examine
Provide essential data to
determine specific
preoperative tests
Review of System: Cardiac
o Report
o Any cardiac problems so they can be monitored during
the intraoperative period
o Use of cardiac drugs
o Presence of pacemaker/ICD
o 12-lead electrocardiogram (ECG)
o Coagulation studies
o Possible prophylactic antibiotics
o Venous thromboembolism (VTE) prophylaxis
Review of Systems: Resp
o Inquire about recent airway infections
o Procedure could be cancelled because of increased risk of
laryngo/bronchospasm or decreased SaO2
o History of dyspnea, coughing, or hemoptysis reported to
operative team
o COPD or asthma
o High risk for atelectasis and hypoxemia
o Smokers should be encouraged to stop smoking 6 weeks before
procedure
o Decreases risk of complications
o Sleep apnea, obesity, and airway deformities affect respiratory
function
Review of Systems: Neuro
o Evaluation of neurologic functioning
o Vision or hearing loss can influence results
o Cognitive deficits can affect informed consent and
cause adverse outcomes during and after surgery
Review of Systems: GU
o History of urinary or renal diseases
o Renal dysfunction contributes to
o Fluid and electrolyte imbalances
o Increased risk of infection
o Impaired wound healing
o Altered response to drugs and their elimination
Review of Systems: Hepatic
o Liver detoxifies many anesthetics and adjunctive drugs
o Hepatic dysfunction may increase risk of postoperative complications
ROS: Integumentary
o History of skin and musculoskeletal
problems
o History of pressure ulcers
o Extra padding during procedure
o Affects postoperative healing
o Body art such as tattoos, piercings
ROS: Musculoskeletal
o Identify joints affected with arthritis
o Mobility restrictions may affect
positioning and ambulation
o Report problems affecting neck or
lumbar spine to ACP
o Can affect airway management and anesthesia
delivery
ROS: Endocrine
• Patients with diabetes mellitus are
especially at risk for:
Hypo/hyperglycemia
Ketosis
Cardiovascular alterations
Delayed wound healing
Infection
Fluid and Electrolyte Status
o Vomiting, diarrhea, or preoperative bowel
preps can cause imbalances
o Identify drugs that alter F and E status such
as diuretics
o Evaluate serum electrolyte levels
o NPO status
o Surgery delay may also lead to dehydration
o Patients with or at risk for dehydration may require
additional fluids and electrolytes before surgery
Nutrition
• Deficits include overnutrition and undernutrition
 Provide extra padding to underweight patients to prevent pressure
ulcers
 May be protein and vitamin deficient
 Identify dietary habits that may affect recovery (e.g., caffeine)
• Obesity
 Stresses cardiac and pulmonary systems
 Increased risk of wound dehiscence, infection, and incisional hernia
 Slower recovery from anesthesia
 Slower wound healing
H&P
o The Joint Commission (TJC) requires a history and
physical
o Findings enable to the provider rate patient for
anesthesia administration
o Indicator of perioperative risk and overall outcome
o TJC requires all patients to have a documented H&P
in the chart. This may be done by an advanced
practice nurse, physician, physician assistant, or
provider in advance of surgery or on the day of
surgery.
Nursing
Examination
Complete
Complete a physical examination
Document
Document relevant findings and share with
the perioperative team
Obtain and Obtain and evaluate results of laboratory
tests
evaluate
Monitor
Monitor blood glucose for patients with
diabetes
Preoperative Teaching
• Limited time available
Address needs of highest priority
Include information focused on safety
Provide written material
Observe and listen to determine amount of
teaching for each session
Anxiety and fear can hinder learning
Give priority to patient’s concerns
o Three types of information
Preoperativ
e Teaching
o Sensory
o Process
o Procedural
Teach deep breathing,
coughing, and early ambulation
as appropriate
Preoperative
Teaching
Inform if tubes, drains, monitoring
devices, or special equipment will
be used postoperatively
Provide surgery-specific
information
Ambulatory Surgery Information
Basic
information
before arrival
Time and place
Responsible
adult needed
Fluid and food
restrictions
What to wear
and bring
Legal
Preparation
o Check that all required forms are
signed and in chart
o Informed consent
o Blood transfusions
o Advance directives
o Power of attorney
Surgeon responsible for
obtaining consent
Nurse may witness signature
Consent
Verify patient has
understanding
Permission may be withdrawn
at any time
Day-of-Surgery Preparation
o Hospital gown
o Patient should not wear any cosmetics
o Observation of skin color is important
o Remove nail polish for pulse oximeter
The patient will wear a hospital gown, and in
most cases, no underwear.
Day-ofSurgery
Preparation
o Valuables are returned to family
member or locked up
o Dentures, contacts, glasses,
prostheses are removed
o Identification and allergy bands
on wrist
Next:
Intraoperati
ve Care